In and Out, With a New Hip

By
Heather Buschman, PhD |
January 04, 2017

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Nearly a million people undergo total joint replacement surgeries each year in the United States. For many, a hip or knee replacement means a lengthy recovery — a couple of days in the hospital, then weeks at a rehab facility. But it doesn’t always have to be that way.

“A few years ago we started noticing that about once a month, we’d essentially perform joint replacement surgery as an outpatient procedure, unintentionally,” said
Scott Ball, MD, orthopedic surgeon at UC San Diego Health. “These patients were simply surprised to find they weren’t in as much pain as they had expected to be post-op, and they were asking to go home less than 24 hours after surgery.”

That’s exactly how it happened for triathlete Drew Renick. He had already had his left hip resurfaced several years before, so when he began experiencing similar symptoms on his right side, Renick decided it was time to have that hip replaced. The hip had lost flexibility, and he was finding it uncomfortable to bike and run. He had developed a limp and he couldn’t even tie his shoes.

In March 2015, Ball replaced Renick’s hip in a procedure that started at around 8 a.m. He was up and doing physical therapy a few hours later, and he was home by 4:30 p.m. that same afternoon.

There are several reasons short hospital stays are increasingly common after joint replacement surgeries, Ball said — less invasive techniques, better anesthesia and better physical therapy, to name a few. But they don’t tell the whole story. Recovery times can also be part mental, and determined by the patient’s preparation and expectations. In Renick’s case, he knew what to expect from the previous procedure on his other hip, and he was determined from the beginning to go home as quickly as he could.

“When you and your doctor both expect you to spend a couple days in the hospital, that’s what you do,” Ball said. “So we decided to make outpatient surgeries intentional, with better pre-operative preparation, for those patients that are amenable to it.”

Ball began to realize that if patients were well prepared ahead of time and knew that leaving that day or first thing the next morning was an option, they’d often take it, like Renick did.

To help patients set and meet their recovery goals, Ball and his team now work more closely with patients before they have surgery. They make sure patients know what to realistically expect immediately after surgery and in the following days, weeks and months, and how best to prepare their homes and loved ones for their recovery. Ball’s patients can take online or in-person classes before surgery, where they cover topics that doctors didn’t used to discuss until after surgery.

“If you were going to take a trip to Paris, you wouldn’t wait until you got there to find a hotel and make plans,” Ball said. “Similarly, the planning for after surgery should be made before the surgery. So we help to educate our patients and get them prepared — like have them pick up crutches or a walker and start practicing with them prior to surgery, get a handicapped parking placard, pick up medications, prepare their home and sometimes see physical therapy prior to surgery for ‘pre-hab,’ as opposed to just rehab after surgery.”

Who’s a good candidate for outpatient joint replacement? Surprisingly, age isn’t really a factor.

“The best predictor of how quickly a person will recover from surgery is how well he or she is moving around before surgery,” Ball said. The healthier and more active a patient is, the more he or she can expect to be up and walking around shortly after joint replacement.

Renick was likely ready to go home the same day as his surgery because he knew what to expect, but also because he didn’t wait until he was completely immobilized by stiffness and pain.

“I was hesitant to undergo surgery the first time,” Renick said. “But once I was back to biking and running, I wish I’d done it five years sooner. So I didn’t wait on the second hip. It’s not worth waiting — you lose too much time that you could be doing the things you love.”

Ball’s team is now finding that about 20 percent of their total hip replacement patients, 50 percent of partial knee replacements and five to 10 percent of total knee replacements are good candidates for outpatient procedures.

“Of course, we don’t want anyone to think we’re going to kick them out before they’re ready — we just want them to know they have the option to leave as soon as they feel up to it,” Ball said. “It’s okay to expect you’ll be ready to go home in less than a day, but it’s also okay if you’re not ready for a couple of days. Each patient has a unique situation with his or her baseline health, available family members and the logistics of his or her home. We like to personalize our care accordingly for each situation.”

Renick is pleased that his hip replacement went so well. He was walking up and down the stairs in the hospital just hours after surgery, he never used crutches and he was back to biking just 30 days later.

“And it wasn’t just pedaling around, I was already biking up Mt. Soledad within the month!” he said. Today, Renick is back to running, cycling, swimming, and just about everything he enjoys doing.